USMLE Step 1 Complete Guide

Step 1 – Studying:

I often get asked about how I prepared myself for Step1 of the USMLE test. What I usually say in response is that it is crucial that you have a particular score in mind before you begin studying. Personally, I was aiming for a score at least above the national mean. Even if I’m not American, I was educated in an American medical school and I’m well aware of how competitive things tend to get when it comes to the USMLE score.

I have to warn you right here and now that I’m not a professional advisor who will lay before you all the tips and tricks required to ace the USMLE Step 1 test. I’m merely here to relay my personal experience, which may hopefully be of some benefit to future candidates.

For all medical students out there, if you’re planning on taking Step 1 at any time in the future, my advice to you would be to work as hard as you can while you’re still a student. Step 1 is not the sort of test that assesses your ability to memorize vast amounts of information but it simply aims at assessing how well you understand what you’ve learnt.

There’s a lot of information to digest but with adequate preparation, you’ll find yourself sailing smoothly through the test questions. Information you need to know includes disease mechanisms and pathophysiologies as well as different clinical and laboratory findings that sometimes may be the only key to solving some of the trickier test questions.

However, you must always keep in mind that not all medial students are created equal. Meaning that what works for one USMLE candidate may not work for another. I personally started to study about four weeks before the exam at an average rate of about eight hours a day. I had my ups and downs, of course and some days were better than others. This worked out nicely for me and I’m just your run-of-the-mill medical student and not some braniac at work. Overall, I found that the following resources worked the best for me:

First Aid for Step 1: A great book full of high-yield goodies to help you get through the test. However, take care because it’s rather abbreviated and while it can help you, it can’t carry you through the test all on its own. I made up for its shortcomings by adding my own notes while studying for some of the core-subjects in Step 1 during medical school (pharmacology, pathology, immunology, etc). So when the time came to actually prepare for Step 1, most of the deficiencies of First Aid were made up for by my own notes. I only revisited the book when needed and spent the precious last few days before the exam burning as many bits of information as possible into my mind.

Robbins Review of Pathology Question Book: To make a long story short, this is not an easy question book. The questions are actually harder than the ones you’re faced with during the test. However, the question structure and the approach required for correct problem solving are similar to of the actual test. A high-yield book that focuses on the heavily tested subjects of Pathology and Pathophysiology.

BRS Pathology: One of my favorite books. It’s suitable for use along with your pathology course in medical school. It covers everything but questions are a bit on the easy side.

BRS Physiology: A great book to sum up all you should know about disease mechanisms and pathophysiologies, which you should have a thorough understanding of before sitting for the Step 1 test. I personally remember being caught up between quite a few ‘up/down’ arrow questions in everything ranging from basic endocrinology to aspects of acid-base balance.

You must also realize that Step 1 will throw at you a variety of CVS and pulmonary graph representation which you need to have an excellent understanding of as well as all the basic physiological formulae and calculations of the body, in addition to pharmacokinetic formulae.

Medical Microbiology Made Ridiculously Simple: Knowledge of basic lab tests for common microorganisms in addition to viral characteristics is expected of you when entering the Step 1 test. This is a high-yield book particularly for viruses which are popular subjects for test questions. Fungi and parasites while slightly less popular, can still pop up in the test every now and then.

You have to know the pharmacological aspects as well because the question stem maybe talking about a microorganism and the symptoms it causes, only to ask you about the suitable antibiotic used for treatment.

Kaplan Pharmacology Lecture Notes: All I can do is sing his book’s praises. A high-yield book that covers all the pharmacology information you need for the test.

Kaplan Biochemistry and Genetics Lecture Notes: You must know the following in Biochemistry if you expect to get the score you want:

– Main enzymes and rate-limiting steps of the different inborn errors of metabolism.

– All the major metabolic cycles and processes such as the TCA cycle, the Urea Cycle, Glycolysis, the electron transport system and its shuttles, fatty acid synthesis etc.

– Vitamins; the enzymes that use them, the symptoms of their deficiencies.

– Basic molecular biology questions which are manageable for any average medical student.

– Diagnostic tests such as PCR, Southern and Western Blot techniques in addition to a basic knowledge of immunoassays, Fluorescence-activated cell sorting and Fluorescent immuostains.

– Hardy-Weinberg problems have been known to pop up. Major hereditary diseases and their modes of inheritance (autosomal, sex-linked, dominant, recessive, etc.) are required knowledge.

Kaplan Anatomy and Embryology Lecture Notes: Anatomy here is intermingled with Physiology. The book may describe the clinical presentation of a patient in the ER and based on the information provided, you’ll have to determine which organ of the body has been injured or at which anatomical level. This is in addition to radiological presentations in the form of MRIs or CTs (particularly head CTs). The neurology section of this book is nothing short of amazing and provides you with crucial knowledge needed for the test including, but not limited to the following:

– Nuclei levels in the spinal cord and brain stem as well as the different nuclei lesions and symptoms, even those that are not common such as Multiple Sclerosis, Syringomyelia, etc.

– Spinal cord nerve tracts and cranial nerve signs.

– The Brachial Plexus, which is extremely high-yield and its Anatomy, should be known by heart in addition to all its lesions and their symptoms.

In Embryology, focus on pharyngeal pouches and the related developmental malformations. If you were never a fan of Embryology and all the memorization that comes with it like me, simply solving its questions is sufficient to get you through.

Kaplan Q Bank: Is not suitably reflective and may be a little behind the times. However, it gives you a good idea about the structure and length of the questions in the Step 1 test. Question modes may range from A-D to A-K and not just the common A-E form. Emphasis when solving these questions should always be placed on proper understanding rather than the score. Try to solve them using all three modes; timed, unused and mixed.

USMLEWORLD: Second and third-order questions here are pretty representative of what goes on during the Step 1 test with regards to the though process involved. Many tricks are usually planted here and there in the question stem that you need to learn how to spot and use to your advantage. Explanations here are more up-to-date compared to Kaplan. Question stems are however a bit short and not like those in the actual test at all. This may cause you a bit of an unpleasant surprise when sitting for the test.

Something that may be a bit of a nuisance is the frequency of spelling mistakes and typos on here.

The USMLEWORLD computer interface is nearly identical to that of Step1 but that’s really not much of an advantage.

It’s an overall good question bank and as always, you must focus on learning rather than scoring. Add your own notes when the occasion calls for it (i.e. something new surprises you) and solve as many questions in different modes as often as you can and you’ll be well-prepared come test time.